Parietal cell antibodies?

[missheid]

Hello, so glad to find others like me. Doc believes I have subclinical PA. I have parietal cell antibodies, but not IFA. I know that doesn't eliminate PA, but blood looks great otherwise. I've been getting twice a month B12 shots for a year. Mostly feel great, except now some stomach issues. Question about my parietal cell antibodies-- latest blood work shows the level at 49. How does that rank? Thanks!

[fbirder]

If you are positive for anti-GPC antibodies then it's more likely than not that you have PA, especially together with low B12. In the UK this test isn't recommended because it's too inaccurate. But the IFAB test is almost as bad - with 50% of people who have PA testing negative.

Blood looking 'OK' doesn't mean 'subclinical' PA. The macrocytic anaemia that your dos is thinking of is not the only sign of PA. Do you have any other symptoms?

Antibody tests tend to be positive or negative. Any single result needs the cutoff value as well as each test lab will have a different one.

[missheid in reply to fbirder]

My doctor said my blood cells are not misshapen, part of the requirement for diagnosing PA. Plus, I do not have any symptoms except a little left arm weakness. Had an upper endoscopy last year and last month. Both times, the stomach appeared atrophied, but biopsies were negative for atrophic gastritis. Now... one year after sub clinical diagnosis...and twice a month B12 shots...I am now experiencing heartburn. The slow stomach emptying that I have had my whole life now seems slower, and a gastric emptying study confirmed it. This was discovered two months ago when I got heartburn out of the blue. The heartburn has lasted for 2 months. I had an upper GI and everything looks fine. Possibly sibo, and we are working on that. Thoughts?

[Gambit62 Administrator in reply to missheid]

low stomach acidity prevents B12 being absorbed - and heartburn is a symptom of low stomach acidity as well as high stomach acidity - you could try having something acidic with your food - I keep bottles of lime juice and lemon juice in the fridge and add them to water and that really helps me with my stomach acidity but other people have other problems.

As fbirder says macrocytosis is not a prerequisite for clinical PA - about 30% of people with a B12 deficiency present with neuro symptoms before any sign of macroctosis appears - it's just a misconception and a myth that comes from the lack of focus on how vitamins really work - the macrocytosis is the result of a deficiency on just one of the many processes in the body that use B12 - and there is nothing that says that this is the first process to conk out - they all conk out at different rates in different people. - may be time to share some of the information from the pinned posts with your GP and encouraging them to learn more about how B12 deficiency operates.

[fbirder in reply to missheid]

My doctor said my blood cells are not misshapen, part of the requirement for diagnosing PA.

Many medics seem to think that a diagnosis of PA requires measurable changes in red blood cells. They're wrong. At least that's what the British Committee on Standards in Haematology say -

Neurological presentation (peripheral neuropathy, sub-acute combined degeneration of the cord) may occur in the absence of haematological changes, and early treatment is essential to avoid permanent neurological disability.

[taka Administrator]

I'm guessing what your doc was talking about re misshapen blood cells was macrocytic anaemia (enlarged red blood cells). You do NOT need to have macrocytic anaemia in order to be diagnosed

with Pernicious anaemia. It can be a sign that you may have PA if you

have it but not everyone gets this - other symptoms including

neurological symptoms can occur without any changes to your MCV which is

a measure of your red blood cell volume.

For example if you also have low iron levels you can have co-existing iron deficiency anaemia which causes smaller than normal red blood cells AND PA which can cause larger than normal red blood cells so the MCV (the mean RBC volume) can appear somewhere in the normal range. Did you have your RDW measured? This is a measure of the distribution in size of your RBCs and can give your doc info on whether you have a wider than normal range of sizes.

[missheid in reply to taka]

My RDW was a 14.5 (ref range 12.3-15.4). So that seems okay, right?

[missheid in reply to missheid]

And my ferritin was a 39 (ref 15-150). Thoughts?

[missheid]

Thanks. My doc is my endocrinologist, who specializes in all autoimmune disease. I have Hashimoto's too. I wonder if I should get a hematologist? And are the guidelines different here in the US than in the UK?

[missheid]

There's just so much conflicting information. Take this for example, a study just out in 2016--ncbi.nlm.nih.gov/pubmed/269... ...which says parietal cell antibodies "can be found in 85-90% of patients with PA. Their presence is not sufficient for diagnosis, because they are not specific for PA as they are also found in the circulation of individuals with other diseases. APCA are more prevalent in the serum of patients with T1D, autoimmune thyroid diseases, vitiligo, celiac disease." I have autoimmune thyroid.

So can you have the antibodies, but not PA? My doc says I'm right on the borderline.

I am mostly concerned at the moment about 2 months of non-stop heartburn, no matter what I do.

Starting probiotics with a probiotics researcher... starting acupuncture.. and starting a regimen with a dietitian.

It's like a full-time job! Anyone else feel that way?